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Joint Committee on the National Broadband Network
Rollout of the National Broadband Network

CAPAMAGIAN, Ms Lisa, Marketing and Strategy Implementation Manager, Tunstall Healthcare

FEAKES, Mr Geoff, Chief Information Officer, Tunstall Healthcare

MORGAN, Mr Gary, Health Services Director, Tunstall Healthcare

Committee met at 19:01

CHAIR ( Mr Oakeshott ): I declare open this public hearing of the Parliamentary Joint Committee on the National Broadband Network. Before calling the first witnesses I ask a committee member to move that the media be allowed to film the proceedings today in accordance with the rules set down for committees, which include not taking footage or still images of members' papers or laptop screens.

Mr MITCHELL: I so move.

CHAIR: Thank you, Deputy Chair. I would also like to welcome new member Senator Dean Smith to the committee. Tonight we intend to start by looking at some matters related to the rollout by hearing from Tunstall Healthcare and then Professor Jan Thomas. At 8 pm representatives from Telstra will appear and our focus will turn to the ongoing issues around Telstra workforce retraining. I now welcome witnesses from Tunstall Healthcare. Although the committee does not require you to give evidence under oath, I advise you that these hearings are formal proceedings of parliament and warrant the same respect as proceedings of the respective houses. The giving of false or misleading evidence is a serious matter and may be regarded as a contempt of parliament. The evidence given today will be recorded by Hansard and attract parliamentary privilege. Would you like to make an opening statement to the committee?

Mr Morgan : Thank you, Mr Oakeshott. I thank the members of the committee for their time and attendance this evening. Tunstall Healthcare is the world's largest provider of medical emergency alarms. It is a company that was established over 55 years ago in the United Kingdom. We operate in 30 countries, we have 200-plus emergency response centres around the world and we look after around 2½ million patients and clients globally. We have got some packs for the members of the committee to take away with them. These packs includes information about Tunstall and the people who use Tunstall services. In the Asia-Pacific region we have some 90,000 clients who are monitored from our emergency response centre in Brisbane and one in New Zealand. We have 72,000 monitored clients—patients—here in Australia and we have nearly 14,000 veterans who have their daily care managed by Tunstall Healthcare for the Department of Veterans' Affairs in Australia. Medical alarm users who are clients are typically aged or at-risk people. They have an emergency medical alarm in their home to help them live an independent life, keeping them out of aged-care facilities and hospitals. In our Brisbane emergency response centre we take over 2,000 emergency calls per day; an average of 500 to 600 of those calls per week require emergency assistance. Tunstall Healthcare, on behalf of those client, will call an ambulance, we will call the fireys, we will call the police and so forth.

Our submission was motivated by our desire to ensure that the safety of our clients is not compromised during the transition across to the National Broadband Network. Tunstall has been working closely with NBN Co. to achieve this. The industry association estimates that there are over 250,000 personal medical alarms in Australia. As of today's count we have 136 of our clients or so living in the NBN footprint—they are eligible; they have taken up the NBN service—and by June next year we estimate that 2,000 of our clients will be on the NBN. What I would like to do now is invite Geoff Feakes, our Chief Information Officer, to talk to some of their concerns that we raised in our submission.

Mr Feakes : Thank you, Gary. As highlighted in the packs that have been distributed around, Tunstall made six recommendations in our submission. These were motivated purely by a wish to ensure that our clients get their emergency help when they require it and when they need it. Of the six recommendations which are listed today, we predominantly want to talk about three. These three are around the establishment of a code of conduct for the RSPs, the establishment of a free call number as an advocacy advisory, and also some discussion points around the AS4607 standard.

Since we submitted the letter, there have been a few changes to the rollout of NBN, and our understanding was that they are currently being provisioned. These are predominantly around the informed consent of the battery backup. It is not an opt-in or an opt-out anymore; it is predominantly an informed consent. There is the recent decision to power the data points of the network termination unit during a mains failure, which we see as a positive, and also a modification for the auto-shutdown functionality from 30 per cent to 50 per cent of remaining battery life during a main failure.

The establishment of a code of conduct for the RSPs was related predominantly to the fact that most users of medical alarms are elderly and, generally, technology-shy. Our concern is that there are some clients who unknowingly or unwittingly may sign up to an RSP who cannot support their medical alarm or deliver the service they require. We would like to see some safeguards in place to protect the vulnerable customer and to ensure that the RSPs adhere to a duty of care for the service they provide. We would also suggest that it be mandatory that the RSP investigate the client's requirements before signing them up to a contract. Further to this, we would suggest that the code of conduct set some response of the RSP in relation to the installation of the medical alarm. There are two other points we would like to raise on the code of conduct: the 10-day cooling off period, which we understand to be currently legislated—we believe that the elderly and some users of the medical alarms may benefit from having that code of conduct to 30 days to give them a greater chance to review the requirements—and also for there to be a review of the financial impact that may be on the client if they pick a service that does not meet their medical alarm requirements.

In relation to the establishment of a free-call number, we believe it is important that every medical alarm patient, client, and resident of Australia have an advocacy service in regard to the benefits and what NBN is actually deploying, as opposed to being an industry representation or an RSP provision service. That way, a client can actually get true information in regard to what NBN is about, what the benefits to them are, and what their requirements are. In relation to standard AS4607, which is the standard for medical alarms in Australia, the section we have referred to predominantly is about battery back-ups. The current AS4607 provides a requirement for 40 hours of battery capacity or battery back-up to be provided to the medical alarm during a mains failure or power failure. The standard at this stage highlights the requirement for 40 hours and that is what the medical alarm actually delivers to every medical alarm user in the country. It is our understanding that the existing NBN NTD, or power supply unit, will supply approximately six to eight hours of battery back-up in the event of a mains failure. That is significantly less than the 40 hours that is currently provisioned. Obviously that is a significant difference in regard to what can be provided to a client during a power failure or an outage of power in Australia.

The concern we have about that is exposure to the patient. Several points that we have raised previously are in relation to the NBN and the safeguard to the client in the residence. We understand there are some solutions that the NBN are legislated, or are attempting to get legislated through, to provide. These include the extending of the battery run time to be approximately 30 hours or greater. We also understand that they are working with the RSPs on who is responsible for the battery management, whether or not the end user or the RSPs, as in the Telstras, Optuses and SkyMeshes will have some role in that. There is also some requirement for modification to the power supply unit that connects to the NTD itself to have a more generic plug so that alternative power supplies can also be sorted. To summarise very briefly, our presentation was predominantly around ensuring that our clients and medical alarm clients can make an emergency call when they need to.

Mr Morgan : Tunstall Healthcare is here with our submission tonight to ensure that our clients, the at-risk clients, the elderly of Australia, the clients that we represent and the clients who use other services from other vendors are able to access emergency help where and when they need it.

ACTING CHAIR ( Senator Cameron ): Thank you. Mr Feakes or Mr Morgan: Tunstall Healthcare—you are not simply suppliers of monitoring alarms, are you?

Ms Capamargian : We supply medical alarms and manufacture medical alarms. We also provide a 24-hour monitoring service.

ACTING CHAIR: So alarms is your main game?

Ms Capamargian : Alarms are our main game, yes.

ACTING CHAIR: Are there opportunities under NBN for companies like yourself who are already in the medical healthcare area to widen the scope of your market and base of the company?

Mr Morgan : Absolutely. Tunstall Healthcare globally has some 50,000 clients and patients who are using our services for telehealth services in Europe and North America. Here in Australia we are currently rolling out some eight or nine telehealth projects. Some of those are in the NBN area and some are serving states like Tasmania.

ACTING CHAIR: I want to come back to that but I want to just touch on the issue of the battery. I suppose battery technology, as I understand it, is changing continually. Ion batteries, for instance, have a very long life.

Mr Feakes : Yes.

ACTING CHAIR: So in terms of batteries the technology will eventually, if it has not done so already, solve the problem that you are raising, wouldn't it?

Mr Feakes : It is our understanding that the battery that is supplied with the power supply unit is a lead-acid battery. It is not my understanding that NBN are provisioning any alternate battery supplies at the moment other than their recommendation for legislative approval to look at other power sources. As battery technology changes, yes, they will adhere to that, but the current unit they are supplying supports six to eight hours of battery supply to the NTD during a mains fail.

ACTING CHAIR: Given this is fundamental to your business plan, have you looked at what alternatives could be implemented by your company?

Mr Feakes : At a technical level we have addressed and looked at the alternatives that are around. The concern we have with regard to battery management is that our clients are generally elderly. It is not just about the supply of a battery; it is about the management of the battery, the alerts and how the client gets the service they require. At the moment, under AS4607, our batteries inside our alarms last for 40 hours. On the existing infrastructure in place now, prior to NBN, during a mains fail we will get their alarm calls through for more than 40 hours—40 hours is our minimum. With the introduction of NBN, as soon as the power supply unit—the NTD—loses power there will be no telephony in or out of that device. Currently, it is my understanding that only the power supply unit and the certified cable are allowed to be used, and there is no modification to those at this stage.

ACTING CHAIR: There are no modifications?

Mr Feakes : It is our understanding from NBN that it is legislated—

ACTING CHAIR: Is that your understanding or is that the fact?

Mr Feakes : I believe it is the fact. At this stage I believe there is legislation from NBN in which they are asking for advice or approval to seek alternate ways that they can power the NTD.

ACTING CHAIR: NBN do not legislate—we legislate.

Mr Feakes : That is why I said 'seeking legislation'.

ACTING CHAIR: That is an interesting point and I am glad you have raised it. I just cannot see any reason technically why in some circumstances there cannot be, for people who are reliant—as your clients are—on long-term response on their batteries, Li-ion batteries that provide more than 40 hours.

Mr Feakes : We have been working very closely with NBN, and NBN have attended our industry representation meetings and are fully aware of our concerns. I believe they are addressing those and seeking legislation to address those concerns moving forward.

ACTING CHAIR: So are you happy with NBN's response?

Mr Feakes : I am happy that they are progressing the requirement we would like to see for extended battery life, and to have a couple of alternatives there looking at how to achieve that for us as an industry. As Gary highlighted, there are about 250,000 patients in Australia relying on the medical alarm daily.

ACTING CHAIR: I do not think I can take that point any further. The other issue you have raised is telehealth and how you deal with that in Europe. Does the NBN allow you to provide better, extra services to your clients?

Ms Capamagian : Absolutely. In fact, the development of the NBN in Australia prompted Tunstall to develop a new integrated telehealth system which is soon to be taken internationally off the back of the NBN. Australia really pioneered the way in broadband-type technologies, and now the UK is starting to roll out broadband in geographic areas. Some of the telehealth programs are now looking to integrate the technologies we have developed here in Australia into their broadband telehealth programs in the UK and Europe.

Mr Feakes : From my point of view, we see the NBN as a real enabler to provide a lot richer service than we have had provided previously. We have always had the A-limited bandwidth in Australia and now with the NBN we get a greater bandwidth so we can deliver a lot richer services, including multi-party videoconferencing. We can include remote telehealth services now which several years ago were not enabled.

Senator GALLACHER: I note that your business functions internationally. Are there any areas where other countries are ahead of what we are doing in Australia, in terms of fibre to the home or telehealth provision? Are there any areas in which you are involved which have fibre and are using it, so a solution has been found to the problem you raised?

Mr Feakes : I believe Denmark has had fibre to the home on services for a long period, but predominantly that is broadband-based, so a lot of telephony services are not deployed that way at this stage. We know that the UK is looking at a lot of fibre-based services. Because of the NBN we have been able to deliver some feature-rich services which globally Tunstall are looking at taking to other markets as well. We believe that globally everybody is moving to faster broadband. We know that New Zealand is looking at a very similar type of solution at this stage. As technology develops, we see that globally these services are being rolled out. Predominantly the reason that Australia is ahead is the size of the country and what we have to try and achieve, which is a little different to a lot of the established European countries.

Ms Capamagian : Additionally, particularly in the UK there are still running the telephony service over POTS parallel to the broadband service. They still have the traditional telephone services in parallel.

Senator GALLACHER: There must be other companies and businesses in the marketplace that rely on a backup battery system outside of telehealth. Are their concerns the same as yours or have they solved the problem?

Mr Feakes : We are a member of PERSA which is the personal medical alarm association for Australia. All of our members have met with NBN and NBN have attended our meetings. As an industry we adhere to AS4607 as a standard. With the provision of the battery backup inside the NTD or for NBN the battery life standard has been reduced and our industry is concerned about that. I believe that other groups have submitted letters in regard to that.

Senator GALLACHER: Are there any actual examples of where the new standards would impinge on patient health? If it is going from 40 hours backup to—

Mr Morgan : Six to eight.

Senator GALLACHER: six or eight, how often do we lose the power for six or eight hours?

Mr Morgan : The standard is 40 hours and with our 72,000 clients and patients around the country in the last 12 months we had some 22,000 power outages notified to our emergency response centre. If you do the mathematics you would see that we had some 60 patients and clients who were impacted by power outages every day in Australia. If you think what is happening in the bushfire season and what happens in the floods—

Senator GALLACHER: I am sitting on two committees and the committee next door is inquiring into electricity, so I could zap in there and ask them the average length of a power outage.

Ms Capamagian : That varies a lot from metropolitan to rural and regional areas. In our experience during the cyclone and during floods we found metropolitan areas—

Senator GALLACHER: I can accept that during cyclones, floods and long-term disasters, but I wonder about the actual instances of power outages over six hours in any capital city or rural area.

ACTING CHAIR: Outside of natural disasters, I think is the question.

Mr Morgan : We record the outages and we have had 22,000 or so power outages with our clients in the last 12 months.

Senator GALLACHER: Have they exceeded six hours?

Mr Morgan : I would have to take that on notice and come back to you with the duration. We record it as an event.

Senator GALLACHER: Outside of your business, an alarm system would have a battery backup for security of premises. They would have a bigger problem than you, wouldn't they?

Ms Capamagian : I am sure the security industry would have very firm beliefs around the battery as well. Part of the concern we have is because we look after a lot of elderly patients or patients who need assistance and there are a couple of case studies in the pack. To a certain extent these patients have 24-7 carers where possible. The problem is that if they lose power during the night, for example, with a 40-hour battery we would get notified that they had lost power but we would know that they would have power in the morning. We did not wake them up to say, 'Margaret, you've lost power' at this stage. When they are longer than the six hours, we can get through the night and work with the client and we can work with family the next day to address those issues. The problem with having a smaller window is that if a power failure happens at say eight o'clock at night, potentially there is no power for the client to press the medical alarm button at four o'clock in the morning with no notification. From our point of view it exacerbates a risk to the client of not having the extended battery backup. We understand the concern is about the battery backup and power failures which might last for one hour or 40 hours. The concern is still the client in the home. As most of us know, if it is two o'clock in the morning when you lose power it is a little disorientating for the patient.

Senator GALLACHER: I fully understand the seriousness of any power outage for someone who is totally dependent on the medical alarm.

ACTING CHAIR: This is not just the alarm. Some of your patients would be reliant on power for other medical devices as well.

Ms Capamagian : Yes, potentially for other services.

ACTING CHAIR: The alarm may be the last issue if there is a power outage.

Ms Capamagian : Yes, but through having the alarm and because we have a whole case record of our clients we are able to assist them in managing the risks around the other services that they may have that are reliant on electricity. We are able to provide notification to the care agency, to family and friends or to other responders or to emergency services to provide alternative support to that person.

ACTING CHAIR: Some people may not be able to get to the alarm if there is a power outage. Are you advised by the power companies if one of your clients is affected by a power outage?

Ms Capamagian : No.

Mr Morgan : We receive a notification before they would know or simultaneously.

Mr Feakes : When there is a mains fail our alarms will detect there is a mains fail. We will send a message to the monitoring centre, as will most alarm-monitoring companies.

ACTING CHAIR: Just like security companies do.

Mr Feakes : Yes, we get that and know a client has lost power. In the event of power being restored, we get a message back in some circumstances. If we do not get a message back after four to six hours and a client is on NBN, that is part of the concern we have about how we manage that.

ACTING CHAIR: NBN are talking to the government about a legislative amendment on the battery.

Ms Capamagian : Yes, that is correct. Currently the battery is only provisioned on the UNI-V port not the UNI-D port. That is one of the issues they are addressing, being able to provide the battery backup to the UNI-D port as well.

ACTING CHAIR: Even if you only had six-hour backup you would be confident that your checks and balances would make sure the patient is looked after, wouldn't you?

Ms Capamagian : Yes, we have put procedures in place to support clients that have shorter backup battery time, so that we can manage risks on their behalf.

ACTING CHAIR: As I understand, there is an aged-care facility in Victoria connected to the NBN with fully functioning medical alarms. Are you aware of that?

Ms Capamagian : There are probably many villages what are connected to the NBN or NBN-like services that have medical alarms.

ACTING CHAIR: There is no threat to safety because you know what the battery backup is and if you were monitoring you would take steps to deal with a blackout.

Ms Capamagian : Yes, if they were our client we would have an understanding of their situation and we would manage that accordingly with the facility manager at the retirement village.

ACTING CHAIR: There is no fundamental safety problem for your clients at the moment; you simply want a more long-lasting battery.

Mr Feakes : Australian standard AS4607 is in place to provision a service for the medical alarm client and patient. What we are looking for is extending the battery backup as currently provisioned by NBN to come back as close as we can to AS4607, that way providing the best outcome for the patient and the client so that we can get through a night or a period of time in the event of a mains fail.

ACTING CHAIR: And an outcome for you. You want that 40 hours.

Ms Capamagian : Ideally, we want the 40 hours. Currently the other concern that we have is that there are clients that RSPs have put in place—the RSP is not aware that the client has a medical alarm, potentially they have only provided a telephone over the data service which currently does not have backup power and the client may not be aware that their alarm will not work in the event of a power outage.

ACTING CHAIR: But there are still problems with the copper network as well, aren't there, in terms of your alarm systems?

Ms Capamagian : It is a very reliable service.


Ms Capamagian : Yes.

Senator GALLACHER: What are the implications of the three to five versus 36 to 40? Is there a financial reason that it is three to six hours?

Mr Feakes : I would suggest that it was probably part of the design that went into the power supply unit that was actually paired or designed with the NTD and the battery at that time. I presume that the design and development of that device has been in the making for a while and I suggest they probably standardised on that battery as part of the development phase. Could they modify that? You would have to talk to the designers of the equipment, but it is a strong recommendation and a request that they extend the battery capacity as much as possible.

Mr Morgan : Our motivation for the submission was to ensure that Australia's elderly and at risk—Tunstall's clients—are able to access emergency services when they require them. The three key messages from our submission are that we would like to see a code of conduct established, we would like to see a 1800 free call service for Australia's elderly and at risk to be able to phone and give information and we would like to see adherence to the Australian standard 4607.

ACTING CHAIR: Thank you very much. We are out of time. Thank you for your submissions.

Mr Morgan : Thank you for the opportunity.

ACTING CHAIR: If you have been asked to provide additional information could you please forward it to the secretariat by Tuesday, 23 October. If the committee has any further questions, we will send them to you in writing through the secretariat.